Pattern and causes of missed appointments in a Nigerian Psychiatric Hospital: A cross-sectional study.

Psychiatric patients exhibit a higher rate of missed appointments compared to other medical specialities, leading to provider frustration, increased relapse, and suboptimal outcomes. This study investigates the patterns and correlates of missed appointments among outpatients at the Federal Neuropsychiatric Hospital in Calabar, Nigeria. A cross-sectional study involving 403 consecutive outpatient clinic attendees was conducted. The study questionnaire inquired about sociodemographic characteristics and hospital utilization. The Oslo Social Support Scale, the Internalized Stigma of Mental Illness Scale, the Perceived Devaluation and Discrimination Scale, and the Treatment Perception Questionnaire were administered. The mean participant age was 36.19 years (SD = 11.25), with females constituting 52.6%. Missed appointments occurred in 16.6%. The primary reasons for missed appointments included financial difficulties, forgetfulness, and distance to the hospital. Factors significantly associated with missed appointments were marital status (married), having children, believing appointments were too frequent, medication nonadherence, and concerns about medication cost (P < .05). Additionally, individuals who received unorthodox or delayed traditional care during their first mental health episode were more likely to miss appointments (P < .05). Missed appointments are prevalent among psychiatric patients, often attributed to financial challenges, forgetfulness, and geographical barriers to the hospital. Some of these factors are modifiable, suggesting targeted interventions in adherence improvement programs are needed.

Challenges and recommendations for addressing under-five pneumonia morbidity and mortality in Nigeria.

Background: Pneumonia is a severe infection and one of the most common causes of mortality among children under five years of age, when not appropriately managed. Infection of the lungs by bacteria, viruses, or fungi and consequent inflammation may lead to cough and difficult breathing. Some of the key predisposing factors are malnutrition and air pollution. WHO reports that Africa has the highest burden of global child mortality, and 16% of all deaths in pneumonia, were children under five years of age in 2016. Objectives: This study aimed to explore how health providers perceive pneumonia as a cause of under-five mortality in Nigeria. Methods: A qualitative study design with in-depth interviews and focus group discussions was used to explore and understand nurses and pediatricians' views regarding the pneumonia situation, vaccinations, and preventive suggestions to reduce under five pneumonia deaths in Nigeria. Results: Two themes and four categories emerged: participant's anxiety over the situation, their views on impediments, current policies and strategies, and suggestions on addressing severe pneumonia. Conclusions: The results from this study highlight contextual issues playing major roles in pneumonia mortality among children in Nigeria, which will need approaches on several levels to address them.

Psychological distress and social media usage: A survey among undergraduates of a university in Calabar, Nigeria.

CONTEXT: Access to social network sites (SNS) is commonplace, especially among young people globally. Cumulatively, long duration of daily exposure may be having effects on psychological health outcomes, including increased and in some cases, decreased risk of depression and anxiety. Despite these potential effects, there is a paucity of literature on patterns and effects of exposure to social media, especially in developing countries where regular mental health screening is generally unavailable. AIM: This study aims to assess the psychological effects of Internet/social media usage among undergraduates in Calabar. SETTINGS AND DESIGN: A descriptive cross-sectional study conducted in the University of Calabar, Nigeria. METHODOLOGY: Multi-staged sampling technique was used to recruit equal proportions of the undergraduate students from five selected Faculties in the University. Internet Addiction Test and General Health Questionnaire-28 were used to measure addiction to Internet and psychological health status of the respondents, respectively. Socio-demographic questionnaire was used to obtain information on demographic and social media characteristics of the respondents. STATISTICAL ANALYSIS: Chi-square and independent t-test were used as inferential statistics, with P value set at 0.05. RESULTS: Four hundred and eighteen (418) respondents completed the questionnaires. The mean age was 21.5 ± 3.6 years. Male:female ratio was 1:0.99. WhatsApp (59.8%) was the most commonly visited social media platform, whereas entertainment (52.2%) was the most common reason for social media use. About one-fifth (20.1%) had moderate-to-severe forms of Internet addiction, whereas one-third (33.1%) were psychologically distressed. Psychological distress was found to be significantly more common among respondents with mild/none, compared with those with moderate-to-severe forms of Internet addiction (P = 0.00). Respondents with moderate-to-severe forms of Internet addiction had significantly lower mean depression and anxiety scores compared with those with mild or no form of addiction (P = 0.00). CONCLUSIONS: There is high degree of psychological distress among students, and this was found to be more common among those that were less/not addicted to SNS. Specifically, high degree of Internet addiction may be protecting against the increased risk of depression and anxiety. The implications of these findings on youth counselling and the prevention of mental illnesses in developing countries are discussed in this article.

Pattern and predictors of Brain Fag syndrome among senior secondary school students in Calabar, Nigeria.

CONTEXT: Brain Fag syndrome (BFS) is a culture-bound disorder that is quite common among Nigerian students. It is known to be associated with study difficulty, and in severe cases, discontinuation of education. Little is known about its pattern and predictors among secondary school (SS) students in Calabar. AIMS: This study aims to determine the pattern and sociodemographic predictors of BFS among SS students in Calabar. PARTICIPANTS AND METHODS: Stratified sampling was used in this cross-sectional study to recruit 1091 students from ten SSs in Calabar metropolis. The students completed the Brain Fag Syndrome Scale and a sociodemographic questionnaire which were used in the survey. Data was analysed using SPSS software version 21. RESULTS: The prevalence of BFS was 20.4%. Female gender, school type and local government of location, residence type, parental marital status and maternal educational status were found to have statistically significant relationships with the disorder (P ≤ 0.05). Significant predictors of BFS were female gender (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.14-2.09) and having parents who were 'not married' (OR = 1.8, 95% CI = 1.24-2.85). CONCLUSIONS: We conclude that BFS is highly prevalent amongst SS students in Calabar metropolis albeit at a relatively lower level compared to similar studies and is significantly predicted by female gender and having parents who are unmarried. We recommend that more research should be performed on this much-neglected psychopathology to elucidate it further, with consequent development of appropriate treatment modalities.

Future options for the management of chronic kidney disease in Nigeria.

The lack of health care infrastructure and prevalence of infectious disease in Nigeria exacerbate the growing problem of diagnosing and treating chronic kidney disease. Nigeria should place more emphasis on chronic kidney disease education, screening, and prevention; propagation of acceptance of peritoneal dialysis over hemodialysis; subsidization of renal replacement costs; and advancement of the national renal transplantation program.

Vascular access considerations for therapeutic apheresis procedures.

The success of therapeutic apheresis (TA), similar to hemodialysis, depends on the integrity of the extracorporeal circuit as well as a reliable vascular access. However, unlike hemodialysis, which requires high flow of blood around 400 mL/minute through the extracorporeal circuit for effective clearance, TA is usually carried out with much lower blood flow rates (<100 ml/minute). Therefore, even peripheral venous access can be considered for TA. The main determinants of the choice of vascular access for TA is the duration of the planned treatment and, to a certain degree, the indication for its use. While peripheral venous access and temporary central venous catheters are sufficient for short-term TA, tunnelled catheters and arteriovenous fistulae (AVF) are usually used for long-term treatments. Because of the large body of evidence in the hemodialysis literature on the advantages of AVF over tunnelled catheters and AV grafts, they should be considered as the preferred access for chronic TA as well. However, advance planning for the care of AVF after creation is of critical importance especially since many of the healthcare providers dealing with TA are less familiar with caring for AVF than nephrologists and dialysis nurses. In this article we first review the similarities and differences between HD and TA procedures. The pros and cons of different vascular access options are discussed next. Finally, we have included a list of recommendations on maintenance of AVF created for TA based on our own experience.

An unusual case of anti-glomerular basement membrane disease presenting with nephrotic syndrome.

Anti-glomerular basement membrane (anti-GBM) disease is a vasculitic disease characterized by acute kidney injury, oliguria, hematuria and proteinuria. Proteinuria is rarely in the nephrotic range. A case of anti-GBM disease with proteinuria of 22.5 g/day is discussed. Immunofluorescence showed strong linear IgG deposits while electron microscopy showed widespread visceral epithelial cell foot cell process effacement. No electron dense immune complex-type deposits were identified. Pathology findings were not suggestive of simultaneous presentation of anti-GBM disease and other diseases associated with nephrotic range proteinuria. Anti-GBM disease should be considered in a comprehensive differential diagnosis of severe proteinuria.